Pathology/Lab Coding Alert

Question: Should I always append modifier 59 to the lower-valued code of an NCCI edit pair?

Tennessee Subscriber
 
 Answer: In most cases, you append modifier 59 (Distinct procedural service) to the lower-valued code, but that's not always the case. A better rule to follow is this: Append modifier 59 to the column-two code (formerly known as the component code) of a code pair edit.

The National Correct Coding Initiative (NCCI) mutually exclusive code list contains edits consisting of two codes (procedures) that a physician cannot reasonably perform together based on the code definitions or anatomic considerations. Each edit consists of a column-one (comprehensive) and column-two (component) code. If you report both codes on the same service date for one beneficiary without an appropriate modifier, Medicare will pay only the column-one code.

When clinical circumstances justify appending a modifier to the column-two code of an edit, the carrier may allow payment of both codes.

Tip: According to CMS, modifier 59 may be appropriate for procedures involving specimens from separate patient encounters or separate (noncontiguous) anatomic sites.

-- Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.